CLINICAL ISSUES :: DIABETES No. (%) Database/Characteristic


IQVIA Total no. of patients Age, mean (SD), yrs


Age group, yrs 0–4


5–11


12–15 16–17


Female sex Hospitalized at index encounter


New diabetes diagnosis† Overall


Pediatric overall COVID-19 Non–COVID-19 ARI


1,698,753 12.3 (4.3)


124,530 (7.3) 483,273 (28.4) 592,830 (34.9) 498,120 (29.3) 850,857 (50.1) 6,473 (0.4)


937 (0.06)


DM type (% of all newly diagnosed diabetes) Type 1 or Type 2


DKA (% of all newly diagnosed diabetes)


891 (95.1)


Due to underlying condition/Other 31 (3.3) Drug or chemical induced


15 (1.6) 241 (25.7) 80,893 12.3 (4.3) 5,930 (7.3) 404,465 12.3 (4.3) 29,650 (7.3) 404,465 12.3 (4.3) 29,650 (7.3) Non-ARI 808,930 12.3 (4.3) 59,300 (7.3)


23,013 (28.4) 115,065 (28.4) 115,065 (28.4) 230,130 (28.4) 28,230 (34.9) 141,150 (34.9) 141,150 (34.9) 282,300 (34.9) 23,720 (29.3) 118,600 (29.3) 118,600 (29.3) 237,200 (29.3) 40,517 (50.1) 202,585 (50.1) 202,585 (50.1) 405,170 (50.1) 566 (0.7)


614 (0.2) 68 (0.08)


64 (94.1) 3 (4.4) 1 (1.5)


33 (48.5) 132 (0.03)


124 (93.9) 6 (4.5) 2 (1.5)


18 (13.6) 1,602 (0.4) 227 (0.06)


210 (92.5) 8 (3.5) 9 (4.0)


50 (22.0) 3,691 (0.5) 510 (0.06)


493 (96.7) 14 (2.7) 3 (0.6)


140 (27.5)


abbreviations: ARI = acute respiratory infection; DKA = diabetic ketoacidosis; DM = diabetes mellitus; ICD-10-CM = International Classification of Diseases, Tenth Revision, Clinical Modification.


TABLE 1. Characteristics of matched pediatric groups with and without evidence of COVID-19 or acute respiratory infection and number of new diabetes diagnoses, by age, sex, and preceding COVID-19 or acute respiratory infection diagnosis IQVIA PharMetrics Plus United States, March 1, 2020–June 28, 2021. Chart courtesy of CDC, https://www.cdc.gov/mmwr/volumes/71/wr/mm7102e2.htm


were for drug- or chemical-induced dia- betes, with the majority of codes being for type 1 or type 2 diabetes. Alternatively, COVID-19 might


have indirectly increased diabetes risk through pandemic-associated increases in body mass index, a risk factor for both serious COVID-19 illness and diabetes. The authors commented that future studies addressing the role of comorbidities and increases in body mass index in post–COVID-19 diabetes are warranted. Although this study provides infor-


mation on the risk for diabetes following SARS-CoV-2 infection, additional data are needed to understand underlying pathogenic mechanisms, either those caused by SARS-CoV-2 infection itself or resulting from treatments, and whether a COVID-19–associated dia- betes diagnosis is transient or leads to a chronic condition.


Increases in pediatric type 1 diabetes Evidence of increased pediatric type 1 diabetes has been reported during the


42 JUNE 2022 MLO-ONLINE.COM COVID-19 pandemic.3,4 Among persons


aged <18 years with COVID-19 and new diabetes diagnoses in this study, nearly one half had diabetic ketoacidosis (DKA) at or around the time of diagnosis. This number was higher than that in com- parison groups, and higher than previous reports of DKA among incident type 1 dia- betes cases before the pandemic (28%) .11 Increased frequency of DKA at time of


diagnosis of type 1 diabetes during the pandemic has previously been reported and was thought to be due to delayed care-seeking for diabetes.5


However, the


observed association of increased risk for diabetes diagnosis following SARS- CoV-2 infection would not be explained solely by delayed care. COVID-19 has disproportionately affected racial/ ethnic minority groups, and those aged <18 years in these groups are also at increased risk for type 2 diabetes.12 An association between COVID-19


and new pediatric diabetes diagnoses might disproportionately affect racial/ ethnic minority groups. Race/ethnicity data were unavailable in the present data sets; however, future studies should


address racial and ethnic disparities in COVID-19 and diabetes, and whether persons aged <18 years who are at risk for COVID-19 are also those at risk for delaying medical care. Healthcare providers should screen


for diabetes symptoms in persons aged < 18 years with a history of SARS-CoV-2 infection. These symptoms can include fre- quent urination, increased thirst, increased hunger, weight loss, tiredness or fatigue, stomach pain, and nausea or vomiting.


The stats The increased diabetes risk among per- sons aged <18 years following COVID-19, highlights the importance of COVID-19 prevention strategies in this age group, including vaccination for all eligible persons and chronic disease prevention and treatment. The COVID-19 pandemic has dispro-


portionately affected people with diabe- tes, who are at increased risk of severe COVID-19. Increases in the number of type 1 diabetes diagnoses and increased frequency and severity of DKA at the time of diabetes diagnosis have been


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